Access to health care in India, especially for women, depends on various factors, such as socioeconomic status, education, caste, religion, geography, urban/rural areas of residence and cultural aspects. Middle age is often defined as the period of life between the ages of 45 to 60 years when one is no longer young, but not yet old. It is expected that in the next decade, 15 per cent of India’s population would be over the age of 40. This implies that almost 20 million people would have specific healthcare needs in this age group. So what are the special challenges in the delivery of health care for women in their middle age?
“According to the World Health Organization, women live longer than men due to biological differences. In India, this is approximately three years more than men. Non-communicable diseases such as cardiovascular disease, stroke, kidney disease, respiratory disease and trauma are the leading causes of death in women worldwide,” says Dr Prathima Reddy, Senior Obstetrician and Gynaecologist, Fortis La Femme Hospital, Bangalore.
What are the medical health issues that are more common in middle-aged women?
Diabetes and Hypertension
The incidence of these two diseases, which were previously thought to be more common in males, is rapidly increasing in women as well. However, this is seen more in urban settings compared to rural areas. Both these diseases, if discovered late or left untreated, can have far-reaching consequences. It is known that the incidence of a heart attack in women with diabetes is 44 per cent more than men and the incidence of stroke is 27 per cent more than men. Kidney disease is also higher in adults with the above diseases.
Obesity, especially in urban areas, is a rapidly growing problem. Three per cent of Indians are obese and 25 per cent are overweight. The factors that have contributed to this are better incomes, lack of exercise, increased consumption of high calorific foods and “junk food”. Obesity increases the risk of heart disease, diabetes, stroke, osteoporosis and worsens arthritis.
The age of menopause in Indian women is between 46 to 48 years. Women going through menopause can suffer from hot flushes, weight gain, depression and osteoporosis. The incidence of some female cancers also increases after menopause.
The incidence of female cancers especially breast, cervix and ovary are higher after the age of 40. Breast cancer is now the most common cancer in Indian women surpassing cervical cancer, which until recently was the most common.
Depression occurs more commonly in women than in men. It has far-reaching effects if not recognised and treated early. Changes in the hormone levels especially before a period, after delivery and during menopause can increase the risk of depression. This is apart from the genetic and environmental factors that can contribute to depression.
Not many Indian women fall pregnant after the age of 40. However, in recent times, due to the wider availability of IVF, women opting to pursue their careers and thus putting off pregnancy till later, more women are pregnant in their late thirties or early forties. These pregnancies can be complicated by chromosomal abnormalities in the foetus (Down Syndrome), a higher incidence of diabetes, hypertension in pregnancy and a higher incidence of caesarean sections.
What can women do to remain healthy?
“Most women tend to neglect themselves at the cost of their families and children. Although this attitude is changing due to better information, education and better incomes, large numbers of Indian women still have limited or no access to health care,” remarks Dr Reddy.
* A regular health check testing for diabetes, anaemia, cholesterol and hypertension at least once a year is recommended.
* Screening for breast and cervical cancer regularly, as recommended by your doctor, is a must.
* Breast cancer can be detected early with regular mammograms and cervical cancer can be prevented by having regular Pap smears.
* Women with a family history of breast, ovarian or colon cancer should discuss this with their doctor.
* Eating a healthy diet, exercising regularly, not smoking, cutting down on alcohol and maintaining a healthy weight will go a long way in preventing disease.
* Finally, seeking medical help early is extremely important in preventing or treating a disease.